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Last Chance For AEP

Last Chance For AEP text overlaying image of an hourglass Every year, from October 15 to December 7, the Medicare Annual Enrollment Period takes place. This is a good time to look over your present Medicare coverage. Does it cover the medicines you need? Are you able to pay for the plan? Are you able to see your favorite doctor through the plan? The Medicare AEP is not the same as the other times you can sign up for a Medicare plan. You can add, change, or get rid of Medicare Advantage plans or stand-alone Medicare Prescription Drug Plans during the Medicare AEP. After that, you can also make the following changes:

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Medicare Options

There is a time every year when people who already have Medicare can switch from Original Medicare (Parts A and B) to Medicare Advantage (Part C). Or the other way around. However, if you want to change, you might have to do some other things too. Changes to and from different types of plans will require you to make different choices.

Switching to Medicare Advantage

In this scenario, you are currently enrolled in Traditional Medicare and are considering switching to a Medicare Advantage plan. In addition to that, you can also have a separate Part D plan for your prescription medication. The majority of Medicare Advantage plans offer comprehensive coverage that encompasses all of your needs. They will pay for your Medicare Part A and Part B benefits. As well as your Medicare Part D prescription medicines and most other health services or items that are not covered by Original Medicare. A few of these additional things are dental, eye, and hearing care, in addition to memberships at fitness centers. To prevent you from spending an excessive amount each year, Medicare Advantage plans come with a cap on the amount of money you are responsible for paying out of pocket.

 

You have the ability to switch from Original Medicare to a Medicare Advantage plan if you do so during the Annual Enrollment Period. If you already have Medicare Part D coverage, but decide to enroll in a Medicare Advantage plan, you may find that you no longer require a separate Part D plan. If you decide to enroll in a Medicare Advantage plan instead of Original Medicare, the plan will coordinate the transfer of your benefits with Medicare. There is no requirement for you to initiate contact with Medicare on your own. Your new plan will begin covering you as of the first of the year. 

Switching to Original Medicare

Only Part A (covering for hospital stays) and Part B (coverage for medical services) are included in Traditional Medicare. It doesn’t cover prescription drugs, dental care, vision care, or fitness programs like some Medicare Advantage plans offer. Because there is no yearly out-of-pocket maximum with Original Medicare, there is also no built-in financial security for beneficiaries.

 

You will need to get additional coverage if you still intend to have these things. For instance, if you want coverage for prescription drugs. You will have to search for a stand-alone Part D plan and sign up for it. Previously, this was not the case. In the event that you determine you require additional coverage, you will be required to select a Medicare Supplement Plan and register for it directly with the issuer of that plan. In order to make the transition back to Original Medicare, you will need to contact either the provider of your Medicare Advantage plan or Medicare itself.

What If I Miss The AEP?

A number of different things might happen, and it all depends on the coverage that is being given right now. What transpires next will be determined by the type of coverage you currently have in place. The majority of people who are enrolled in Medicare have either Original Medicare with a Part D prescription medication coverage or Medicare Advantage together with a Medicare Supplement insurance policy.

Missing The AEP With a Medicare Advantage Plan

During the AEP, beneficiaries who are enrolled in Medicare Advantage plans have the opportunity to make modifications to their coverage. If you do not enroll in the new plan during the Annual Enrollment Period, your existing plan will be transferred to the new plan automatically. One possible exception to this rule is if your existing Medicare Advantage plan moves out of the area it serves or is terminated. In the event that this takes place, you will be eligible for a Special Enrollment Period. The SEP will extend for two months after the Part C program has concluded.

 

You have the ability to make modifications to the Medicare Advantage Open Enrollment Period if you are enrolled in a Medicare Advantage plan and you are currently enrolled in the plan. Every year, the MAOEP begins on the first of the year and continues until the end of March. You have the opportunity to make changes to your Medicare Advantage plan during this period of enrollment. If you do not enroll during the AEP or MAOEP, you will not be able to change your plan until you have a Special Enrollment Period that meets the requirements.

 

Imagine you are only eligible for Original Medicare, and you fail to enroll during the Annual Enrollment Period. If this is the case, the only way for you to add a Medicare Advantage plan or a Medicare Part D plan is if you have a Special Enrollment period during which you are eligible to do so.

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Missing The AEP With a Part D Plan

If you miss the AEP, your existing plan will carry over into the following year. Just like it would with a Medicare Advantage plan, unless the program is discontinued. If you miss the enrollment period for a program and then decide you want to switch to a different one, you won’t be able to make the switch unless there is a special enrollment period. An SEP is triggered by particular occurrences in a person’s life as well as unusual conditions. 

Options After Missing The AEP

Even if you miss the Annual Enrollment Period for Medicare, you still have choices available to you to obtain health insurance.

Special Enrollment Period

You may be able to make changes to your Medicare coverage outside of the Medicare Annual Enrollment Period if you meet the requirements to qualify for a Special Enrollment Period (SEP). There are numerous instances in which you may be eligible for a SEP. Some of these circumstances could result in you losing your health insurance coverage, either temporarily or permanently. The following are some instances of circumstances that may qualify you for a Special Enrollment Period, which allows you to join up for a Medicare Advantage plan or a stand-alone Medicare Part D prescription drug plan, or alter your current plan, without having to wait for regular enrollment periods.

 

  • You moved out of your plan’s service area.
  • You moved into, out of, or still live in a skilled nursing facility. Or another institution such as a long-term care hospital.
  • You left your employer-based or union-based health insurance.
  • You used to be eligible for Medicaid, but now you’re not.
  • You just got out of jail.
  • You’re moving back to the United States after living outside the country.
  • Your plan is losing or ending its contract with Medicare.

Keep in mind that these are only some examples. If you suffer significant changes to your plan, your coverage, or even your health, it may be worthwhile to check with Medicare to see if you may qualify for a Special Enrollment Period to change your coverage. This can be done if you contact Medicare after you have experienced any of the aforementioned changes. There is a possibility that various SEPs will have varying durations. Your specific circumstances will determine how much time you have to make the adjustment. But in most cases, you will have at least two months to do so.

COBRA Coverage

After certain qualifying events, such as the loss of a job or a reduction in the number of hours worked, individuals who are eligible are able to continue their employer-sponsored health insurance coverage for a limited amount of time through COBRA coverage, which is an abbreviation for the Consolidated Omnibus Budget Reconciliation Act. It can provide temporary coverage and assist you in bridging the gap until you find alternative options for health insurance.

 

If you are qualified, you have the opportunity to continue receiving health insurance coverage from your employer even after you have left your position there. This enables you to keep your present health benefits after becoming eligible for Medicare, which is a significant advantage. It is crucial to check with your employer to understand the precise rules and requirements for remaining on your company’s plan while still being eligible for Medicare. This information can be obtained by checking with your employer.

Wait For The Next AEP

In the event that you don’t qualify for any SEPs or any other special enrollment choices, you will have to wait until the subsequent open enrollment period in order to make any modifications to your Medicare coverage. Both the AEP and the IEP are considered to be the most important enrollment periods. You have the ability to make modifications to your current Medicare plan. Or enroll in a new plan for the following calendar year during these enrollment periods. It is essential to be aware of these enrollment times. And to make appropriate preparations in order to guarantee that you will have the necessary coverage.

Help From EZ

If you miss the Medicare Annual Enrollment Period, you can find yourself in a stressful situation. Agents located in your area are available through EZ.Insure to provide assistance and answer any questions you might have. Our sales representatives have received extensive training to assist you in selecting the solution that is most suited to meet your requirements. Estimates for Medicare Supplement Plans will be sent to you by our agent. Who will also assist you in signing up for coverage at no additional cost. These estimates will come from the leading insurance companies in your area. Simply enter your zip code in the box below to get free immediate quotes. If you would like to speak to a local licensed representative, you can call us at 877-670-3602.

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Fibromyalgia and Medicare

fibromyalgia and medicare text overlaying image of an older woman trying to relieve pain in her neck Fibromyalgia, a medical illness that causes musculoskeletal pain throughout the body, affects approximately 4 million people in the United States. While it is not an age-related disease, the symptoms are more severe in seniors. It can cause severe pain and make daily tasks difficult. There is still a lot of mystery surrounding this condition, but there’s been a lot of headway in the diagnosis and treatment process. So, if you have fibromyalgia, you may be asking what treatments are available to you and whether Medicare will pay for them.

What is Fibromyalgia?

Fibromyalgia is a chronic (long-term) condition. It causes symptoms such as soreness, fatigue, muscle tenderness, and even difficulty sleeping. The condition is very complex and shows in a variety of ways, so much so that even healthcare specialists struggle to completely understand the disorder. This is because its symptoms all mimic symptoms of other illnesses and there is currently no definitive test to confirm a diagnosis. So, Fibromyalgia is often misdiagnosed for years before being found. 

 

In the past, some doctors even questioned if fibromyalgia was real. This resulted in widespread “lazy” and “dramatic” stereotypes of those suffering from fibromyalgia. However, as the disease has been examined more thoroughly, some of the stigmas that once surrounded it have faded. Doctors have been able to find medication, therapy, and lifestyle changes that can all help you manage your symptoms and live a better life.

Fibromyalgia Symptoms

Fibromyalgia has a long list of symptoms including:

 

  • Fatigue
  • Trouble sleeping
  • Nonrestorative sleeping (sleep without feeling rested)
  • Headaches
  • Difficulty focusing (called Fibro Fog)
  • Dry eyes
  • Rash
  • Itching
  • Pain in the lower abdomen
  • Bladder problems
  • Depression
  • Anxiety

The most noticeable sign of fibromyalgia is pain. Most fibromyalgia patients have small tender spots around but not in the joints. When pressure is applied to these spots they can cause anything from a dull ache to severe pain. These areas, known as the 18 fibromyalgia trigger points, are symmetrical, appearing on both sides of your body with 9 spots on each side.

Since there is no specific test for fibromyalgia doctors used to diagnose fibromyalgia based on the above symptoms combined with pain in at least 11 of the 18 trigger points. However, the American College of Rheumatology (ACR) modified clinical practice recommendations and removed the minimum trigger point limit from the diagnosis criteria. 

18 Trigger Points

Behind the Neck

Fibromyalgia patients frequently have two trigger points in the back of their neck where their skull meets the neck. Fibromyalgia may also cause a stiff neck, cramping, and limited range of motion. However, keep in mind that neck pain and stiffness is not limited to fibromyalgia. As we noted most symptoms will mimic other conditions. Neck pain can be caused by arthritis, trauma, over-exertion, bad posture, or even sleeping on it at an odd angle. 

Front of Neck

The trigger points on the front of the neck are above the collarbone on either side of your larynx. Pain in the front of the neck can also be caused by arthritis, injury or swollen glands. So before diagnosing fibromyalgia, your doctor will most likely order blood tests to rule out any rheumatological causes first. 

Shoulders

Shoulder trigger points are around midway between the edge of your shoulder and the bottom of the neck, where the supraspinatus muscles attach to the shoulder blades. People with fibromyalgia may suffer scorching or throbbing pain in this area, as well as shoulder stiffness, in addition to pain when pressure is applied. Tendonitis, rotator cuff tears, and adhesive capsulitis (commonly known as frozen shoulder) can all produce pain in the supraspinatus muscles, which form part of the rotator cuff.

Chest

Fibromyalgia pain spots on the chest are found near the second rib on either side of the sternum (also known as the breast bone). That sore point is felt at the costochondral junction, the cartilage that links the rib to the sternum, a few inches below the collarbone. Some fibromyalgia patients may feel significant pain that begins at the tender point and radiates over the chest, a condition known as costochondritis.

Upper Back

Fibromyalgia pain points in the upper back are positioned immediately below the shoulder blades, where the trapezius muscles meet the scapula. In addition to the tenderness, you may experience discomfort across the trapezius. In fact, a 2013 study found that people with fibromyalgia have much higher trapezius muscle tension when exposed to mental stress than others. A spinal disk condition, arthritis, or an injury can also all cause pain in that area.

Elbows

Tender spots on the forearms associated with fibromyalgia are right below the elbow crease toward the outside of the arm. These trigger spots might appear on either one or both elbows. Fibromyalgia is often linked to lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow), both of which are forms of tendinitis. Both can result in discomfort and tingling down the forearm to the hands and fingers. Elbow discomfort can also be caused by injuries or illnesses unrelated to fibromyalgia, such as arthritis, gout, and lupus.

Lower Back

Lower back fibromyalgia pain sites are located towards the top of the buttocks, where the gluteus maximus and gluteus medius muscles connect. Fibromyalgia can also produce muscle pain, spasms, and stiffness across your entire back and buttocks. This type of pain is also common in people who do not have fibromyalgia. In the United States, one out of every four adults suffers from low back discomfort. It can be caused by problems with the vertebral disks, spinal misalignment, repeated stress injury, or an inflammatory condition.

Hips

The hip trigger points are located directly below the hip bone, roughly where the buttock muscles bend and connect the thigh muscles. In addition to the trigger points, people with fibromyalgia may have muscle soreness and limited range of motion in the hip area. Hip discomfort can be caused by osteoarthritis, muscular strains, and other injuries. When attempting to narrow down a diagnosis, X-rays and other imaging studies can sometimes rule out alternative illnesses. Imaging scans can assist distinguish between pain caused by joint degeneration, osteoarthritis, and myalgia (muscle pain).

Knees

Tender spots in the knee are found on the inside of the leg. The specific pain site lies directly above the side of the knee near the bottom of the vastus medialis muscle. Fibromyalgia-related knee pain may be accompanied by joint stiffness and cracking. Joint swelling, on the other hand, is not typical of fibromyalgia. If your knee is also swollen, it could be caused by another ailment such as knee osteoarthritis, a meniscus injury, bursitis, or an inflammatory disease.

Fibromyalgia Treatment

Unfortunately, there is currently no cure for fibromyalgia. Instead, medications, self-care practices, and lifestyle changes are used to reduce symptoms and improve quality of life.

Medications

Medications can help you sleep better and decrease pain. Pain relievers, anti-seizure medicines, and antidepressants are common fibromyalgia medications.

Pain Relievers

Fibromyalgia pain can be unpleasant and persistent enough to disrupt your everyday routine. If your discomfort is minor, you can take over-the-counter pain medicines such Tylenol, Aspirin, Motrin, or Aleve. These drugs can help you manage your disease by reducing your pain and discomfort. They may even help with your sleep.

 

Many of them also reduce inflammation. Inflammation is not a prominent symptom of fibromyalgia, although it may occur if you have a linked disorder such as rheumatoid arthritis (RA). Opioids have also been prescribed to treat fibromyalgia pain. However, research has revealed that they are ineffective over time. Furthermore, the dosage of narcotics is often increased rapidly, posing a health danger to those administered these prescriptions.

Anti Seizure Medication

Pregabalin (Lyrica), an anti seizure medication, was the first medication approved by the Food and Drug Administration (FDA) for fibromyalgia. It prevents nerve cells from delivering pain signals. Gabapentin (Neurontin) was developed to treat epilepsy, but it may also aid with fibromyalgia symptoms. Gabapentin is an off-label medicine that has not been approved by the FDA to treat fibromyalgia. Off-label drug use is when a medicine licensed by the FDA for one purpose is also used for a second, unapproved purpose.

 

A doctor can continue to prescribe the medicine for that unapproved purpose. This is due to the fact that the FDA regulates drug testing and ensures that the drug is safe to take but they don’t regulate what the drug can be used for. As a result, your doctor can prescribe a medicine in whatever way they believe is best for your treatment.

Antidepressants

Antidepressants such as duloxetine (Cymbalta) and milnacipran (Savella) are sometimes used to alleviate fibromyalgia pain and fatigue. These drugs may also assist to restore neurotransmitter balance and promote sleep. Both duloxetine and milnacipran have been approved by the FDA for the treatment of fibromyalgia.

Fibromyalgia Diet Changes

Some fibromyalgia patients claim to feel better when they follow a specific diet plan or avoid particular foods. There is no evidence that any specific diet changes will improve or cure fibromyalgia entirely but there are changes that are known to help some of the symptoms associated with fibromyalgia.

 

If you have fibromyalgia, aim to eat a well-balanced diet in general. Nutritious foods give you a steady amount of energy and help you keep your body healthy. They may also help to keep symptoms from worsening. Doing simple things like eating more fruit and lean proteins, and lowering sugar intake can all help balance your diet. Certain foods or substances, such as gluten or monosodium glutamate (MSG), may aggravate your symptoms. Keep a food diary to note what you eat and how you feel after each meal if this is the case. Share this journal with your doctor so they can assist you in determining which meals worsen your symptoms.

Natural Remedies

If drugs and dietary modifications do not completely improve your symptoms, you can explore other options. Many natural cures focus on stress reduction and pain relief, and they can help you feel better both psychologically and physically. They can be used alone or in conjunction with established medical treatments. Natural fibromyalgia treatments include:

 

  • Physical therapy
  • Acupuncture
  • Massage therapy
  • Meditation
  • Yoga
  • Tai Chi
  • General exercise
  • Therapy
  • Cognitive Behavioral Therapy

It’s worth noting that most alternative remedies for fibromyalgia haven’t been properly researched or confirmed to be effective. Before attempting some of these methods, consult with a healthcare practitioner about the advantages and dangers.

Medicare Coverage For Fibromyalgia

Medicare may cover some of the costs of your fibromyalgia treatment. Part B (Medical Insurance) can help pay the price of medical visits and diagnostic tests. If you are hospitalized for your disease, Medicare Part A may cover the costs of your hospital stay as well as any medicine you receive while in the hospital. 

 

Part D, or prescription drug coverage, might help you save money on prescriptions you need. If you’ve been diagnosed with fibromyalgia in the last year and your current coverage isn’t meeting your needs, think about your alternatives during the Annual Election Period, which runs from October 15 to December 7. Pricing tiers will be established for each plan, based on generic, brand-name, and mail-order medications.

How EZ Can Help

If you need additional coverage, you can purchase an affordable Medicare Supplement Plan. Medicare Part B covers a lot, however it only covers 80% of your expenses, leaving you to pay the other 20% out of pocket. This can be rather costly, especially if you are on a fixed income, as many Medicare recipients are. However, by obtaining a Medicare Supplement Plan, you can save money on medical expenses while also receiving additional coverage. 

 

There are ten Medicare Supplement Plans to choose from, each with its own set of coverage options and pricing. To save as much money as possible, it’s recommended looking into a Medicare Supplement Plan, so talk to an EZ agent about all of your alternatives. EZ’s agents work with the best insurance carriers in the country and can compare plans for you in minutes at no cost. Simply enter your zip code in the box below to get free instant quotes, or call 877-670-3602 to speak with an agent directly.

Does Medicare Cover Genetic Testing?

Does Medicare Cover Genetic Testing? text overlaying image of a dna strand The Centers for Medicare and Medicaid (CMS) has begun covering genetic sequencing in 2018. It began when the FDA approved FoundationOne CDx, a test that can detect over 300 types of gene mutations. While Medicare does cover genetic testing to help detect possible health conditions it only covers a few types of genetic testing, and you have to meet certain criteria. Typically, genetic testing is used to screen, identify, or plan a specific treatment. That means without having certain symptoms or being at risk for certain health conditions Medicare won’t cover genetic testing. In most cases your doctor will be the one who advises you to get genetic testing done. For example, if you have a hereditary risk for a certain disorder. Along with testing to check the effectiveness of a new medication, this would help your doctor determine a better treatment plan. 

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Types Of Genetic Testing

Mainstream adult genetic testing covers several conditions. These are usually categorized by function:

  • Diagnostic, Predictive, or Presymptomatic – These tests are for patients who may have symptoms or know a certain medical condition runs in their family. A genetic test can show indicators for various cancers, polycystic kidney disease, and hemochromatosis. However, having indicators does not mean you will develop the disease. It just means you have the genes that can trigger it.
  • Carrier – Even if a person never gets sick or shows signs of a disease, they may be a genetic carrier for that disease. A test that looks for DNA markers that show a person is a carrier of an inherited disease can tell them if they could pass this gene on to a child or if they already have. If the other parent is also a carrier, this test can also tell them if they have already passed this gene onto a child.
  • Pharmacogenomic – The study of genetics is a big part of learning how the body breaks down drugs or responds to them. In some cases, a person’s genes can show whether or not a certain treatment will work or cause a bad response. This can help doctors tailor their treatment plan to the patient’s needs. Which can improve the chances of the patient’s health and healing going well.

Are There Risks To Genetic Testing?

Most genetic tests have very few risks and may be as easy as swabbing the inside of a patient’s cheek. Other tests may need a sample of blood. Which can cause some of the usual side effects of having blood taken. This could lead to redness or soreness in the place where the injection was given. Genetic testing, like any test, can also lead to changes in your mental health. Depending on how bad the scenario is, genetic testing can take an emotional toll. This could happen while deciding if a genetic test is needed, while waiting for the results, or after a genetic problem has been confirmed. This is natural since the possibility of serious medical conditions can be scary. 

 

Keep in mind, genetic tests might be able to find out if a person has genetic markers linked to hereditary conditions. But they don’t tell us how likely it is that a person will get the disease. Or how signs might change or get worse over time. The health care worker who does the genetic test can tell you if there are any limits to the test and what it is usually used for.

Genetic Testing With Medicare

As we noted before, Medicare will pay for only a few types of genetic testing if you meet Medicare’s standards. If your doctor suggests that you get a genetic test it will most likely be covered because it will stem from a set of symptoms you’ve been showing. These are the genetic tests Medicare will cover:

  • Molecular Diagnostic Genetic Test (MDT) – Involves looking at gene sequences for changes that could cause certain illnesses.
  • Next Generation Sequencing (NGS) – NGS is a type of genetic testing that looks at many different parts of a person’s DNA at once. It helps doctors figure out how changes (mutations) in your DNA can show risk factors. And help them figure out what’s wrong with you.
  • Pharmacogenomics (PGx) – As we noted above, this is a type of test designed to learn how your body will react to certain types of medication.

Medicare also pays for NGS genetic tests for both acquired cancer (caused by gene mutations) and germline cancer (which is passed down from parent to child). Medicare will also cover some types of genetic tests that are used to diagnose cancer. These tests help find biomarkers, which are signs of abnormal cell activity in your body. For example, Medicare pays diagnostic tests for breast cancer, prostate cancer, ovarian cancer, and pancreatic cancer for people who have never been tested for specific mutations (BRCA).

BRCA Testing

Medicare pays for genetic tests that look for changes in the BRCA 1 and BRCA 2 genes. Which are the breast and ovarian cancer genes. Medicare also pays for other genetic tests that can tell if someone has a BRCA gene. Research shows that both men and women with the BRCA 1 or BRCA 2 gene mutations are much more likely to get breast and ovarian cancer than people who don’t have these gene mutations. A test like NGS that looks at many genes at once can find changes in BRCA 1, BRCA 2, and other genes. This can help doctors figure out if someone has cancer or not. There is criteria to get testing for BRCA 1 and BRCA 2:

 

  • You have to have pre-testing genetic counseling
  • Testing must be relevant to your family history of cancer
  • National Comprehensive Cancer Network rules say that you must meet certain standards to be eligible for testing for breast cancer or another type of cancer and one other type of inherited cancer.

When Does Medicare Cover Genetic Testing?

Medicare will pay for genetic testing for certain conditions and PGx for medications. As long as your doctor orders it and it is done in a lab that is approved by the Clinical Laboratory Improvement Amendments (CLIA).

 

Medicare covers genetic diagnostic testing for specific gene changes and NGS multi-gene panel testing if you have been diagnosed with cancer. If you meet Medicare’s requirements, NGS testing is also covered for other inherited diseases. Such as heart problems (cardiomyopathy, which is a problem with the heart muscle) and arrhythmia. Coverage for the Individual Plan may change based on where you live. For some medicines, PGx testing is also covered. Many medicines are broken down in the liver by enzymes like CYP2C19, CYP2D6, and CYP2C9. Doctors and pharmacists can better focus your medication therapy by testing your genes for these enzymes.

 

Medicare will pay for PGx testing for certain drugs like warfarin, clopidogrel, amitriptyline, and others if certain conditions are met. Your doctor can tell you more about the perks of PGx testing for you. The company that gives you your Medicare plan can tell you which PGx tests are covered by your plan. Medicare also lets MACs decide if they will cover NGS genetic tests that are not FDA-approved and other types of NGS genetic tests. For instance, for other types of cancer and other health problems.

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Cost Of Genetic Testing

How much a genetic test will cost you varies based on the type of test, how it’s done (saliva or blood sample), and whether or not you meet the requirements for Medicare coverage. If your test is covered, you won’t have to pay anything as long as your provider accepts Medicare assignment. This means they agree to the payment terms set by Medicare. Costs for genetic tests can range from a few hundred to a few thousand dollars. So, it is important to make sure that Medicare pays for the test. Medicare has rules about who can get testing, and your doctor must give you an order for it. Medicare Administrative Contractors (MACs) may also have eligibility standards based on where you live.

Counseling With Genetic Testing

Medicare rules say that a “cancer genetics professional” like a doctor can give genetic advice. Which is covered, but you have to be a patient of that doctor. Certified genetic counselors are not yet seen as health care experts by Medicare. So, if you see a genetic counselor who is certified, your visit may not be paid. Certified genetic counselors have special training in genetics and therapy, so they can help you understand how your genes affect your chances of getting diseases like cancer. Based on the rules in place, Medicare doesn’t pay for genetic advice for any screening or prevention tests. Your Medicare plan provider can tell you more about the coverage standards for genetic counseling.

Get Covered With EZ

Medicare is great, but sometimes it can be hard to understand. Even after you sign up, you’ll still have to make some decisions about your health care. Don’t worry about asking questions. Talk to an EZ agent who can tell you what you need to do to sign up and explain everything to you. EZ can help you sign up, buy a Medicare Supplement Plan, or just think about your choices. Our insurance brokers work with the best firms in the country. You can get a free review of all the plans in your area from them. We’ll talk with you about your medical and financial needs and help you find a plan that meets them all. Call one of our certified agents at 877-670-3602 to get started.

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Medicare Annual Enrollment Period (AEP) FAQ

Medicare Annual Enrollment Period (AEP) FAQ text overlaying image of building blocks with faq written on them. If this is your first year participating in the Medicare Annual Enrollment Period (AEP), you may be confused about what you need to do. Getting the information you need is crucial if you want to make sure your Medicare plan is ready for the upcoming year. You could lose hundreds of dollars if you don’t fully understand the AEP and don’t take advantage of it. We have compiled and addressed some of the most commonly asked questions we receive this time of year in an effort to better prepare you for the AEP. 

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What Is The AEP?

A specified window of time known as the Annual Enrollment Period (AEP) allows people to modify their Medicare coverage. It enables Medicare enrollees to change their plan selections to better meet their medical needs. The AEP can be used by eligible people to switch, enroll in, or disenroll from any Medicare plan. Including Original Medicare (Parts A and B), Medicare Advantage (Part C), and Medicare prescription drug coverage (Part D). Including the options to enroll in or modify Medicare prescription medication coverage, move between Medicare Advantage plans, and convert from Original Medicare to Medicare Advantage. 

When Is The AEP?

Every year, the AEP takes place from October 15 to December 7. Unless you are eligible for a Special Election Period (SEP), the AEP is usually your opportunity to make these adjustments if, during your initial enrollment period, you did not enroll in a Medicare Advantage or Medicare prescription drug plan. Any modifications you make during the AEP take effect on January 1st of the following year.

Why Is The AEP So Important?

There are several reasons you might think about changing your Medicare coverage since your healthcare needs change over time. All Medicare beneficiaries should be aware of the costs associated with premiums, deductibles, and copayments. If your current plan is too costly, moving to a more affordable alternative can help you control your medical spending. When you undergo specific health changes, switching Medicare plans can also be helpful. Some people have pre-existing ailments that get worse with time, or they develop chronic conditions. In these situations, you might want to think about moving to a Medicare plan that provides better coverage along with condition-specific care management services. By doing this, you can make sure that you have access to the care, drugs, and assistance you need to maintain your health.

What’s The Difference Between Original Medicare and Medicare Advantage?

Original Medicare consists of two portions that are provided by the federal government: Part A and Part B. Hospital insurance, or Part A, is typically premium-free and includes skilled nursing facility care, inpatient hospital treatment, lab testing, surgery, and home health care. As long as you worked 10 years and paid Medicare taxes. Part B medical insurance has a monthly payment that is determined by your income and covers physician services, outpatient treatment, medical equipment, home health care, and certain preventive services. Under a contract with the federal government, private insurance firms offer Medicare Advantage Plans, often known as Medicare Part C. In addition to other benefits like dental, hearing, vision, and/or prescription medication coverage, they cover the same benefits as Medicare Parts A and B.

Do I Have To Change My Coverage?

No, if you are happy with your current Medicare plan, you don’t need to change it. However, you should be aware of any impending changes for the future year and shop around to make sure you are getting the features you need at a reasonable cost.

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What Are The New Medicare Changes In 2024? 

Every year, the Medicare program in the United States may alter somewhat or significantly. Before AEP, every year the Centers for Medicare and Medicaid Services (CMS) announces these changes in September and October. Increases in Part B and Part A cost-sharing, higher Part B premiums (but flat or slightly lower Part A premiums), modified income-related premium surcharges for Part B and Part D, the removal of Medicare Part D coinsurance once an enrollee reaches the catastrophic coverage level, and expanded availability of the full Low-Income Subsidy (Extra Help) for Part D prescription drug coverage are some of the changes to 2024 Medicare coverage.

Medicare Part A Changes

Certain home healthcare services, skilled nursing facilities, and inpatient hospitals are covered by Medicare Part A. For those who have worked for 40 quarters or more who are insured by Medicare, there is no premium for Medicare Part A. CMS estimates that 99% of Medicare enrollees do not pay a Medicare Part A premium. CMS said that the monthly Part A payment, which is paid by beneficiaries with less than 30 quarters of Medicare-covered employment and some individuals with disabilities, will drop to $505 in 2024 by $1. Your premiums stay at $278 if you or your spouse have worked 30 to 39 quarters. The Medicare Part A deductible for inpatient hospital services will rise to $1,632 by an additional $32. The daily coinsurance payments for Part A will be as follows:

 

  • $408 for days 61–90 of hospitalization during a benefit period
  • $816 for lifetime reserve days
  • $204 for days 21–100 of extended care services in a skilled nursing facility during a benefit period

Medicare Part B Changes

Medicare Part B is medical insurance, which pays for doctor visits along with other services and supplies that are required for medical care. It also includes ambulance services and preventive treatment to avoid illness. In addition, several kinds of outpatient prescription medication, mental health coverage, and durable medical equipment are included. Medicare Part B is going to get more expensive in 2024. In 2024, the average monthly premium for Medicare Part B will be $174.70, representing a nearly 6% increase over the 2023 payment. The Medicare Part B premium was $164.90 in 2023. Additionally, the yearly Medicare Part B deductible will rise from $226 in 2023 to $240 in 2024. Increases in spending are the main cause of cost changes.

Medicare Advantage Changes

Under a contract with Medicare, private businesses provide Medicare Advantage plans (Part C). Medicare Advantage plans, which offer Part A, B, and occasionally D (drug) benefits, are enrolled by around 50% of Medicare beneficiaries. Lower rates and appealing extras like gym memberships, dental, vision, and hearing coverage are features found in most policies. 

 

Selecting “in-network” providers is a requirement of MA plans. You might have to pay extra or not receive coverage at all if you travel outside the network or coverage area of the plan. According to CMS reports, it expects Medicare Advantage premiums to remain relatively unchanged in 2024 compared to 2023. Medicare Advantage monthly premium averages should be $18.50 in 2024 as opposed to $17.86 in 2023. For over 73% of beneficiaries, there will be no rise at all.

Medicare Part D Changes

CMS anticipates a decrease in Part D premiums in 2024 to $55.50 in 2024 from $56.49 in 2023. The Inflation Reduction Act of 2022 caused multiple policy adjustments, which is why there has been a drop. In 2024, new cost-sharing restrictions take effect. There is a temporary cap on the amount of coverage provided by Medicare prescription drug plans, known as a coverage gap. This coverage gap is called the “donut hole.”

 

The donut hole begins when your insurer and you spend $5,030 on covered pharmaceuticals, which is more than the $4,660 in 2023. Following $5,030, you will have to pay a part of your prescription medications out of pocket, up to the amount specified by your plan. Upon reaching this threshold, whether you purchase your prescriptions from a pharmacy or online, you won’t be required to pay more than 25% of the total cost of the medication (brand-name and generic). Once you cross that threshold, your coverage resumes. 

 

You get into the catastrophic coverage phase once you’ve spent the maximum amount of money you can for covered medications ($8,000 in 2024). This stage results in the elimination of cost-sharing for approved medications in 2024. More individuals will also be eligible for expansion of Extra Help in 2024. This will allow Medicare beneficiaries who meet certain requirements can receive fixed lower copayments instead of a premium and deductible. Participants can save roughly $300 a year on average.

Can I Change My Medicare Plan Outside of The AEP?

It depends on the situation. You will have the opportunity to make adjustments during your Special Enrollment Period, for instance, if you move outside of the coverage area of your plan or if you no longer qualify for coverage for any other reason. Of course, you can always leave a Medicare Advantage Plan, prescription drug plan, or Supplemental Plan whenever you choose, but you can’t join or modify them unless you are eligible for a Special Enrollment Period (AEP). 

How Do I Enroll During The AEP?

It is possible to enroll in a Medicare plan through assessing your options and selecting one on your own, but working with a qualified Medicare agent is recommended to avoid missing out on a fantastic, cost-effective plan. The Medicare representatives at EZ can help you every step of the way and compare all of your Medicare options. As well as help you find a Medicare Supplement Plan from the best insurance providers in the nation. 

Working With EZ

If you have any additional questions about medicare & medicare supplement plans feel free to reach out to an EZ agent. Our local agents are here to help you compare plans, find plans that fit in your budget, go over your coverage, and keep you up to date with everything you need to know about your plan. To get a medicare supplement quote online you can enter your zip code in the bar below. To speak to a live agent you can give us a call at 877-670-3602.

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How ESRD and ALS Affect Medicare

How ESRD and ALS Affect Medicare text overlaying image of a senior and younger persons hands holding When you think of Medicare you likely think of the health insurance system designed for people over 65, but there are some cases where younger people are also on Medicare. Some people with disabilities who are younger than 65 can get Medicare. These people must have been getting disability payments from Social Security for at least 24 months or have End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s disease). So, if you have one of these conditions, it’s important to not only look into and compare all of your plan choices, but also make sure you sign up for Medicare at the right time.

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ESRD

End-stage renal failure, also called end-stage renal disease (ESRD), is the last and final stage of chronic kidney disease. In this stage, the kidneys’ function has gotten so deficient that they can’t function on their own anymore. A person with end-stage renal failure needs dialysis or a kidney donation to live longer than a few weeks. As kidney failure worsens, patients may feel a wide range of symptoms. Some of these are tiredness, drowsiness, less urination or not being able to pee, dry skin, itchy skin, headache, weight loss, nausea, bone pain, changes in skin and nails, and being easy to bruise.

 

If you have been told you have end-stage renal disease and need a kidney donation or are getting dialysis, you can sign up for Medicare on the first day of your fourth month of dialysis. If you are taking part in a program to help you do your own dialysis, you will be qualified for Medicare right away. However, if you stop doing self-dialysis and start going to a dialysis center, your Medicare benefits will stop and you will have to go through 4 months of dialysis before you can start getting them again. 

ESRD Medicare Coverage

A doctor must tell you that you have ESRD before you can get ESRD Medicare. Also, you must have enough work history to qualify for Social Security Disability Insurance (SSDI) or Social Security retirement benefits. You can also apply based on your spouse’s or parent’s work history. Depending on your treatment plan, Medicare for ESRD will start when:

 

  • If you start a training program for home dialysis, which is sometimes called “self-dialysis,” you can get Medicare as of the first day of the first month of the program. Before your third month of dialysis, you must start the program. Your doctor must also say that they think you can finish the program and that you will keep doing home dialysis after the program is over.
  • If you get dialysis at a center for inpatients or outpatients, you can get Medicare starting on the first day of the fourth month you get dialysis. For instance, if you start dialysis on May 10, your ESRD Medicare coverage can begin on August 1.
  • If you need a kidney transplant, you can get Medicare starting the month you are admitted to a Medicare-approved hospital for the transplant or for health services you need before the transplant. If you need a kidney transplant, you can get Medicare starting the month you are admitted to a Medicare-approved hospital for the transplant or for health services you need before the transplant.

What’s Covered?

As long as you meet the requirements, you won’t have to pay a premium for Medicare Part A, but you will have to pay a monthly premium and meet a yearly deductible for Medicare Part B coverage, just like everyone else who has Medicare. Parts A and B of Medicare will pay for:

 

  • Dialysis
  • Kidney transplant
  • Transplant drugs after a covered transplant
  • Dialysis-related drugs

Part B covers outpatient dialysis, which is why you should sign up for Medicare as soon as possible so that this expensive treatment is covered. Immunosuppressant drugs used after a kidney donation are now covered by Medicare, thanks to a law passed in 2019. Before this law was passed, many Medicare recipients couldn’t afford to pay for these drugs out of pocket. 

ALS

Amyotrophic lateral sclerosis is a motor neuron illness that kills people. It is defined by the loss of nerve cells in the brain and spinal cord over time. It is often called Lou Gehrig’s disease after the famous baseball player who died from it. ALS is one of the most debilitating diseases that affect how nerves and muscles work. ALS does not affect the brain or the senses, like being able to see or hear. It is also not infectious. There is no cure for this sickness right now. People of any race or ethnicity are most likely to get ALS between the ages of 40 and 70, though it can happen at a younger age. 

ALS Medicare Coverage

If you have been identified with ALS, you will automatically be enrolled in Medicare the month you start getting disability payments from Social Security. If you have Amyotrophic Lateral Sclerosis (ALS), you are automatically enrolled in Medicare the first month you get Social Security Disability Insurance (SSDI) or a train disability annuity.

 

Once you know you have ALS, you should fill out an application for SSDI or a railroad disability annuity and send it to Social Security or the Railroad Retirement Board. Before you can start getting disability payments, you will have to wait five months. Make sure to say that you have ALS in a clear way on your application for disability payments. Once you’ve waited five months, your Medicare will start the same month as your unemployment payments. Coverage includes services like:

 

  • Physical and occupational therapy
  • Speech-language therapy
  • Medicines used in intravenous infusions

After you sign up for Parts A and B, you can choose between a Medicare Supplement Plan and a Medicare Advantage plan. You can save money on Part B out-of-pocket costs with a Medicare Supplement Plan.

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Medicare Costs Under 65

Original Medicare (Parts A and B) costs the same for both people over 65 and people under 65 who are disabled, but the prices of Medicare Supplement plans are very different in big ways. Most of the time, Medicare supplement plans cost a lot more for disabled Medicare recipients under 65 than for Medicare recipients over 65. Many people with Original Medicare buy Medicare Supplement insurance to cover care that isn’t covered by Medicare Parts A (hospitalization and inpatient care) and B (outpatient care). Parts A and B cover about 80% of the costs, so you need extra insurance.

 

Most states do not offer Medicare Supplement insurance to Medicare recipients under the age of 65, or they are too expensive for this age group. For example, a Medicare Supplement Plan G insurance costs $179 a month for a 65-year-old woman who doesn’t smoke and lives in the Tampa, Florida, area. However, if she were under 65, that same plan would cost $479 a month.

 

There are no federal laws that say insurance companies have to sell Medicare Supplement policies to people under 65, and most states do not have laws about how much the plans can charge Medicare recipients under 65. Insurance companies don’t want to sell these plans to people with disabilities because they are high-risk customers. Because of this, Medicare Supplement Plans for Medicare recipients under 65 can be hard to find and can cost a lot more than in other states.

States with guaranteed issue and pricing regulations

In these states, Medicare Supplement policies must be sold to Medicare users under 65 with disabilities. These states also require insurance companies to keep policy costs low.

States with some Medicare Supplement availability

In these states, insurers must offer at least one Medicare Supplement insurance to people under 65 who are already on Medicare.

 

States where all 10 plans are available but cost more

In these states, insurance companies are required to offer all Medicare Supplement Plans to people under 65, but the states let insurance companies charge high rates.

 

States with variable availability and alternatives

In these places, Medicare enrollees who are under 65 and have a disability and don’t qualify for a full Medicare plan are not required to get a supplemental policy. However, these states have other kinds of insurance, like high-risk insurance pools, that can cover them.

 

States with no requirements

These states are not required to offer Medicare Supplement Plans to Medicare recipients under 65.

 

 

Finding the Right Medicare Option

Knowing that having ESRD or ALS won’t stop you from joining Medicare or getting coverage for your treatment should put your mind at ease. Depending on your condition, you may have to wait for coverage, but once you are ready for Medicare, you will have choices for more help. For example, you can sign up for a Part D plan to cover your prescriptions, and you can buy a Medicare Supplement Plan to help pay for your Part B out-of-pocket costs, since Part B only covers 80% of your medical bills.

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What Are Part B Excess Charges?

What Are Part B Excess Charges? text overlaying image of someone writing medicare on a whiteboard While shopping for Medicare Supplement Plans you might see something called a Part B excess charge. You’ll specifically see this term in the discontinued Medicare Supplement Plans C and F. Providers who take Medicare usually also take Medicare assignment, which is the amount Medicare will pay for certain services. So, thankfully, excess charges don’t happen very often for most Medicare recipients. However, a doctor may choose to accept Medicare insurance, but not Medicare assignment which means they can charge more in some cases. The difference between the higher charge and the Medicare-approved amount for medical services, supplies, or equipment is the excess charge.

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Medicare Assignment

There’s no guarantee that a doctor or hospital will only charge Medicare-approved amounts for their patients just because they take Medicare patients. All of the services and procedures that Medicare agrees to pay for have set prices that they will pay. In other words, the medical service provider must “accept Medicare assignment”. Which means they agree to take the Medicare-approved amount as payment for the service or equipment. After that, the provider sends a bill for the amount owed straight to Medicare. Medicare usually pays 80% of the bill, leaving the patient to pay the last 20%. If a provider doesn’t “accept assignment,” they can charge up to 15% more than the Medicare-approved amount for Part B.

 

If you go to a participating provider, all you have to pay for approved services is your Medicare deductible and coinsurance. This is the case even if the provider charges people with other types of health insurance more. Your participating provider will also send your bills to Medicare.

 

There are also providers who won’t take Medicare assignment. These are called “nonparticipating providers.” If your provider doesn’t participate, they might or might not agree to accept Medicare assignment for specific services. There are usually limits on how much doctors and other medical workers can charge when they don’t accept Medicare assignment. However, there is usually a limit on how much more they can charge for the service.

Medicare Part B

Part B of Medicare usually pays for care and services given in clinics and other outpatient settings. Medicare Part B pays for a range of medically necessary outpatient services and care. The Centers for Medicare & Medicaid Services say that medically necessary services are “services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.”

 

The Part B deductible must be paid before Part B will pay for most medically necessary treatments during the year. For most covered services, you have to pay 20% of the cost out of pocket through Part B. Part B of Medicare also covers services and care that keep you from getting sick. Such as cancer and some other diseases’ screenings, tests, shots, and guidance. For most preventive services, you don’t have to pay anything, but for most medically important services, you have to pay 20% of the cost.

How Much Is The Excess Charge?

“The limiting charge” is the most that non-participating providers can charge you for some medical services and products that Medicare covers. This limit says that Medicare-accepting providers who are not participating can charge you up to 15% more than Medicare’s amount for the same services. This is an example: Medicare has agreed to pay providers $300 for a service you need. Your provider won’t work with Medicare, and they’ll charge you the full legal amount, which is 15%. In this case, the extra charge for you would be $45.

 

In another instance, Medicare pays $100 for another service you receive. Your provider doesn’t take Medicare assignments, but they’ll only charge you an extra 6%. In this case, the extra charge is $6. It’s important to note that not all services have a limit and there is no cap on how much non-participating suppliers of durable medical equipment can charge you for goods and equipment. Make sure your doctor accepts assignments before you get any durable medical equipment.

How Common Are Excess Charges

A 2020 issue report from the Kaiser Family Foundation says that 99% of doctors who aren’t pediatricians accept Medicare. Also, 98% of doctors who take Medicare are participating providers, which means that most Medicare-approved visits shouldn’t have an excess charge. Although there are many medical providers in the United States, even a small number of providers who don’t accept assignments can add up. This is why you should always check with your provider to see if they take assignments before making appointments or buying medical supplies and equipment.

Does Every State Allow Excess Charges?

It can be a pain to deal with Part B extra charges, but luckily some states are against them. The state has to allow excess charges to happen. If they don’t, Medicare recipients in those places won’t be charged more than the Medicare approved amount. Because Part B excess charges are different in each state, it’s important to know what’s going on if you don’t want to have extra Medicare charges added to your bill. Some states either don’t allow extra charges or put some kind of cap on them, but not all of them do. 

 

  • Connecticut – People who are in the Medicare Savings Program at the Qualified Medicare Beneficiary (QMB) level are the only ones who can’t be charged extra. Everyone else in Connecticut who has Medicare Part B can face excess charges.
  • Massachusetts –  Balance billing is illegal in the state, so doctors who take Medicare can’t charge their patients more than the approved amount.
  • Minnesota – Under Minnesota law, Medicare excess charges are not allowed. However, there is an exception that ambulance services and medical equipment are able to have excess charges.
  • New York – The Balance Billing Law of New York says that excess charges can’t be more than 5% above what Medicare allows.
  • Ohio – Excess charges are prohibited in Ohio.
  • Pennsylvania – Pennsylvania does not allow excess charges.
  • Rhode Island – This is another state that does not allow excess charges.
  • Vermont – This state also prohibits excess charges entirely.

How Excess Charges Can Affect You

Say you go to a doctor who isn’t a participant to get a few moles removed that look odd. Medicare will only pay $400 for this treatment, so the dermatologist could charge you $460. If you’ve already met your Part B deductible, the treatment would cost you $140 out of pocket. This includes your $80 coinsurance payment of 20% plus the $60 Part B extra charge. With a participating provider, the most you would have to pay out of pocket is $80. It’s important to remember that excess charges do not count toward your Part B payment.

 

However, a doctor who isn’t participating can add extra charges to your bill as many times as they want. If you often see a provider who doesn’t take assignments, you could end up paying hundreds of dollars more each year than you should.

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Medicare Supplement Plans That Cover Excess Charges

There are only two Medicare Supplement plans that protect you from Medicare Part B extra charges– Plans F and G are those plans. In the past, Medicare Plan F gave the most benefits of all the Medicare Supplement plans. Many people thought it was worth the extra cost because it filled in some of the holes in Medicare Parts A and B.

 

The main thing that makes Plan F better than other Medicare Supplement plans is that it pays for the yearly Medicare Part B deductible. However, in 2015, this changed. People who became eligible for Medicare after January 1, 2020, can no longer get Plan F. People who already had Plan F before the change have the option of keeping it. If you could have gotten Medicare before January 1, 2020, but chose not to, you might also still be able to sign up for Plan F. 

 

Plan G is now the most popular Medicare Supplement Insurance plan that anyone, regardless of when you enroll in Medicare, can get. Plan G pays for the “gaps” in Medicare benefits, which are the costs you have to pay for yourself after Medicare pays its share of the bill. More of these costs are covered by Plan G than by any other Medicare Supplement Insurance plan for new Medicare users.

Why Is Plan F Discontinued?

The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law in 2015. This law made it illegal to sell any Medicare Supplement plans that covered Part B deductibles for people who became eligible after January 1, 2020. There are only 2 of 10 Medicare Supplement Plans that have this benefit, Plan F and Plan C. The new law did not change anything about the plans themselves. If you had or were eligible for one of these plans before January 2020 then the coverage is still the same. The only thing that changed was that new enrollees can no longer purchase the plans and eventually the plans will be entirely phased out once nobody on Medicare is eligible or has one of these plans.

Working With EZ

It is very important to compare the pros and cons of each Medicare Supplement Plan before choosing one. That takes a lot of work because you have to call a lot of insurance companies to get rate quotes, which can take a long time. You can check prices in half the time if you work with an EZ agent. When you work with a qualified agent, you can compare Medicare Supplement Plans from a number of different companies and plans all in one place. 

 

Your agent can tell you about the changes between each plan and compare prices for you. Your adviser can also help you compare out-of-pocket costs and premium costs to find the plan that will save you the most money in the long run. Call us at 877-670-3602 right now to start looking for a Medicare Supplement Plan. To see online quotes you can also type your zip code into the box below.

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